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Case:Tabby
1. Tabby is 4 1/2 years old 2. Has food allergy and gets severe diarrea if he is not on Iams Lamb and Rice 3. He weighed 21lbs and now weighs 15lbs 4. Was diagnosed 8/22/05 5. Male and neutered 6. Glipizide did not work 7. Have changed him to all wet FF from the Janet and Binky list, this gave us a honeymoon phase for a couple months but urine cow pattiess came back. 8. Started on PZI Vet, moved to Levemir, changed again to BCP PZI. 9. Eats Friskies with brewers Rice. I have found the brewers rice firms up Tabby's stools. History Started insulin (PZI Vet) 11/23/05 at 2U BID. Spotty BG numbers at the beginning because Tabby was difficult to home test. :*PS readings before breaking glucose toxicity in the 300s, 400s, and 500s, but would find occasional low numbers. :*Dosage as high as 4U before breaking glucose toxicity. Did various experiments with the timing of food until finding a good approach: I feed 1/2 at +1 and the other half at +2. Didn't like the highs and lows of PZI idexx so we changed to Levemir. We tried that for a little while but it seemed too gentle for Tabby. Also his nadirs were his ps numbers. He would start low and go up and than back down until shot time. I couldn't wrap my head around the way Levemir worked. Now we are using BCP PZI and I find it keeps Tabby more stable. But I am finding it hard to keep the insulin good. Seems the vial should be good for 6 months and we can't get a month out of it before it's like shooting water. Not sure of the reason and we are working on that now. We will try mixing the insulin like BCP tells us in the new insert. Further Reading Full BG level history in his profile on the FDMB. Examples of BG Readings Before Breaking Glucose Toxicity 1/1/06 Tabby has been on 2.5u for 30 days and still getting high numbers, so we will try 3units BID amps 380 1st day raised to 3u and fed +4 1/2 405 +6 399 snack pmps 3units bedtime snack 1/2/06 amps 480 3u and fed day 2 on 3units +5 snack pmps 347 1/3/06 amps 458 3units fed am snack pmps 378 3units fed bedtime snack 1/4/06 am 3 units fed am snack pmps 436 3units fed bedtime snack (salmon and reg. snack) Will be giving spoon of salmon as treat for testing pricks. 1/5/06 amps 554 3units fed (at my wits end) +6 474 snack pmps 443 3units fed bedtime snack 1/6/06 amps 478 3 units and fed +10 453 pmps 3units 1/7/06 First day on 3.5units(use U40 so I'am eyeing it) amps 321 3.5units fed 1/2 can food +3 398 +6 249 fed 1/2 can food +9 319 pmps 379 3.5 units fed 1/2 can food bedtime snack 1/2 can food 1/8/06 amps 537 3.5 units 1/2 can food (why 500 that is the question)didn't eat all +6 370 1/2 can food (ate all) pmps 395 3.5 units 1/2 can food (ate all but a few drops) bedtime snack 1/2 can food Examples of BG Readings as Breaking Glucose Toxicity 1/18/06 +10 1/2 174 +11 197 +11 1/2 231 amps 301 4 u +3 297 +6 256 +9 285 pmps 327 4u 1/19/06 amps 308 4u pmps 397 4u 1/20/06 +12 137 +12 1/2 177 +13 amps 221 4u +2 1/2 298 +6 121 +6 121 +8 140 +11 143 pmps 196 3.5u +3 296 1/21/06 amps 153 3.5u +4 268 +6 254 +9 312 pmps 313 4u 1/22/06 Will spread out feedings amps 165 4u +3 108 +4 87 +5 70 +6 41 +7 71 +9 106 +11 158 pmps 182 3.5u 1/23/06 amps 208 3.5u +6 147 pmps 374 3.5u 1/24/06 amps 172 3.5u +6 147 pmps 179 3.5 Recent BG Readings 1/25/06 amps 111 3u +3 90 +6 63 +8 89 +10 99 pmps 106 1u 1/26/06 amps 135 2u +6 109 pmps 223 3u 1/27/06 amps 321 3u +6 171 pmps 116 2u 1/28/06 amps 336 3u pmps 289 2.5u 1/29/06 amps 141 2.5u +6 72 pmps 223 2.5u 1/30/06 amps 123 2u +3 97 +6 83 +11 73 +12 106 pmps +13 146 2u +11 105 1/31/06 amps 118 1.5u +6 111 +10 105 +11 1/2 89 +12 1/2 105 pmps +13 161 1.5u 2/1/06 amps 115 1u +1 136 +2 1/2 200 +6 352 +10 1/2 pmps 419 2u +3 306 2/2/06 amps 330 2u +6 149 +12 78 +13 pmps 148 1.5u 2/3/06 amps 369 1.5u +1 .5u +6 163 +10 82 +12 113 +13 pmps 148 1.8u 2/4/06 amps 1.8u +6 72 +8 65 +10 128 pmps 184 1.8u +11 404 2/5/06 amps 416 1.6u +6 287 +10 298 pmps 378 1.6u 2/6/06 amps 192 1.6u +6 216 +10 145 pmps 156 1.6u 2/7/06 amps 159 1.6u +6 86 + 7 1/2 128 pmps 372 1.4u 2/8/06 amps 142 1.4u +5 94 pmps 1.2u 2/9/06 amps 207 1.2u + 2 1/2 207 +6 168 Observations on Breaking Glucose Toxicity As Tabby broke glucose toxicity, I had to slowly reduce his dose, constantly looking for markers of rebound. Tabby is not rebound-prone, so the markers are subtle, often a slightly raised PS after a good mid-cycle reading. Tabby also is not hypo-prone; he can reach some relatively low BG levels without going lower and without having hypo symptoms. He has been able to achieve a low, flat curve on the PZI Vet. When I reduce Tabby's dose, he often has a higher PS on the next cycle. I have to fight the urge to raise his dose immediately back up. He usually smoothes out in a couple of cycles. I had to learn to use overlap and carryover to keep his curve flat. 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